tbuckley/cabot-search huggingface dataset:
Study of practice patterns in NGS vs single gene testing, provider-identified barriers to biomarker testing and utilization of liquid biopsy across multiple hospital-based cancer centers.
Authors: Lijo Simpson, Anju Mathew, Jeremy Stapp
Journal: Journal of Clinical Oncology (2023)

e18743 Background: Limited data exists on next-generation sequencing (NGS) testing rates, utilization of single gene tests for therapy matching, use of liquid biopsies in therapy selection, or physician-perceived barriers to testing in hospital-based cancer centers. Initial project goal is to establish a baseline for such metrics. Methods: 700 patient records of various solid tumor types were assessed as part of a quality improvement project at three different cancer centers over a six-month period: 1) a regional IDN, 2) an NCI center, and 3) a community cancer center/affiliate of an NCI center. This was combined with qualitative surveys on current state practices and barriers to NGS testing completed by thirty (30) respondents from these institutions (97% physicians, 3% nonphysicians). Site specific Physician champions were recruited to identify additional interventions to be implemented at their respective site(s). Results: Baseline findings show 45% of advanced cancers received any biomarker tissue testing, with testing rates of 53%, 25%, and 66% in lung, pancreas, and colon cancers, respectively. Broad-based panel testing made up 59% of tests, and 31% of patients continue to receive single gene testing only. Approximately one third of patients who developed recurrent disease had biomarker testing (38%) compared to patients with an initial diagnosis of advanced cancer where more than half received testing (51%). Use of liquid biopsies was limited, representing 4% of biomarker testing, but 71% of the time it was incremental to completed tissue testing. Three types of testing barriers were identified by survey respondents: 1) 63% cited limited quantity of tissue available, 2) 53% cited reimbursement concerns including “potential cost to patient,” and 3) 44% cited cumbersome process due to delays and long turnaround times for authorization, ordering, and/or delivery of results. Conclusions: 1) A lower number of patients with disease recurrence are obtaining broad panel NGS compared to patients with de novo metastatic disease; 2) There continues to be low utilization of liquid biopsies for patients with advanced cancers; and 3) Single gene tests continue to be used for therapy matching in a large number of patients with advanced cancers. Improving testing rates including use of broad panel tests and liquid biopsies appropriately will require ongoing education and/or automated reminders to cancer care teams. Further education needs to focus on reimbursement concerns at an institutional level and on testing patients who recur after initial cancer diagnosis and therapy.
Survival associations and driver oncogene overlap for copy-number amplifications of <i>ERBB2</i>, <i>KRAS</i> and <i>MET</i> in non-small cell lung cancer.
Authors: Alexander Watson, Harris Benjamin Krause, Andrew Elliott, Alex Patrick Farrell, Stephen V. Liu, Patrick C. Ma, Ari M. Vanderwalde, George W. Sledge, David Spetzler, Erin Lynn Schenk, D. Ross Camidge
Journal: Journal of Clinical Oncology (2023)

9084 Background: Next-generation sequencing (NGS) to detect targetable oncogenic driver mutations is standard of care in non-small cell lung cancer (NSCLC). However, the interpretation and clinical impact of copy number amplifications (CNA) of driver genes is less clear. ERBB2, KRAS and MET are oncogenic drivers with intersecting resistance mechanisms and evolving therapeutic landscapes. We examined the overlap between other oncogenic drivers and CNA of these genes, and the association of CNA with overall survival (OS), in a cohort of patients with NSCLC. Methods: NGS of DNA (592 genes or WES)/RNA (WTS) was performed for 5870 consecutive lung adenocarcinoma tumors submitted to Caris Life Sciences (Phoenix, AZ). The copy number of each exon was determined by calculating the average depth of the sample along with the sequencing depth of each exon. Driver oncogenes (Driver+/-) were defined as pathogenic fusions in ALK, NTRK (1,2 and 3), RET and ROS1 or pathogenic SNVs/indels in ALK, BRAF, EGFR, ERBB2, KRAS, MET. Tumor mutational burden high (TMB-H) was defined as 10 mutations per MB. The χ² test was applied as appropriate ( p &lt; .05). Results: The cohort was 55% female; median age was 69 years (range 24-89) and similar across all cohorts. Incidence of CNA at different amplification thresholds was correlated with oncogene drivers. At CNA ≥6 for ERBB2 and KRAS, but CNA ≥4 for MET, a significant tendency for mutual exclusivity with driver mutations was observed (log2 odds ratio ERBB2: -3.1, KRAS: -1.1 , MET: -2.2 , all p &lt; .001). Tumors meeting these thresholds were designated CNA-High ( Gene-H), versus CNA-Low ( Gene-L). Only one tumor harboured two CNA-H genes ( KRAS and MET). Independent of CNA status, the TMB-H frequency was decreased in Driver+ tumors (27% vs 52% in Driver-, p &lt; .001). CNA-H tumors were associated with decreased OS (compared to CNA-L); for ERBB2-H, hazard ratio (HR) 1.74 (95% CI 1.44-2.10, p &lt; .001), for KRAS-H HR 1.29 (1.16-1.65, p &lt; .001), and for MET-H HR 1.46 (1.28-1.68, p &lt; .001). Similar results were observed when stratified by driver mutation status (Table), with the exception of KRAS/Driver- tumors. Conclusions: These data suggest tumors with high CNA of ERBB2, KRAS and MET represent clinically distinct entities and are significantly less likely to harbour concurrent driver oncogenes. The association between increased copy number and worse OS suggests amplified tumors are an important area for therapeutic development. Overall survival (collection to last contact) for ERBB2, KRAS and MET CNA-High versus CNA-Low tumors, by Driver mutation status. [Table: see text]
Awareness of symptoms, risk factors, and barriers to seeking help related to breast cancer among university students in Mexico City.
Authors: Marlid Cruz Ramos, Mariana Alcalá, Fernanda Sarahi Fajardo Espinoza, Alberto Patiño, C. Lizette Galvez, Jorge Romero
Journal: Journal of Clinical Oncology (2023)

e18652 Background: In Mexico, about 15% of young women (age ≤ 40 years) have breast cancer (BC). However, only 40% of women in this age group know that they should practice self-examination, and only 30% know the proper technique. Additionally, studies carried out in this group show reasons for delaying diagnosis like emotional barriers when a sign is identified, and lack of knowledge of risk factors. The purpose of the present study is to identify knowledge about self-examination techniques, lifestyle, and risk factors that influence the development of BC in university students. Methods: In this exploratory study, we used a 10-section and 55-question questionnaire based on validated international tools such as the Cancer Awareness Measure (CAM) questionnaire (CAM), the National Survey of Trends in Health Information, and the Mediterranean Diet Score (MDS), as a healthy eating pattern. Results: A sample of 53 health sciences school students was analyzed, 93% were women, and the average age was 21 years old. 83% of the students did not feel capable of recognizing signs of BC. Regarding risk factors knowledge, 78.9% recognized using hormone replacement for more than 5 years, 32.7% early menarche age, 98.1% having a closer relative with BC, 63.4% drinking more than 1 unit of alcohol by day, 65.4% being overweight; as risk factors for BC. Interestingly, 32.7% consider being sedentary as a risk factor, however, 43.8% disagree or strongly disagree. The same happens with being overweight, the 34.6% did not recognize this condition as a BC risk. Higher meat consumption was present in 54.9% of the participants. Related to barriers to receiving medical attention if they had symptoms, 21.2% feel embarrassed and 30.8% are scared to see a doctor, 30.8% are too busy, 44.3% are worried about other things, 46.2% are worried about medical findings. Conclusions: Although there was a high recognition of non-modifiable risk, the students dismiss the lifestyle as a risk factor for BC and are not capable to recognize BC signs. It is important to develop interventions to increase knowledge of these risk factors and promote healthy lifestyles from a young age to improve BC prevention. The present study gave us information to design educational strategies, based on the identified needs, that can be implemented as a cancer prevention strategy in this age group. It is also necessary to implement BC cancer prevention education strategies in health sciences school students to improve their knowledge.
Efficacy and safety of pazopanib in the treatment of pediatric sarcoma: Retrospective cohort study.
Authors: Emel Cabi Unal, Sonay Incesoy Ozdemir, Nurdan Tacyildiz, Handan Dincaslan, Caglar Dogrul, Ezgi Guven, Melek Yaman Ortakoylu, Asli Bozer, Gulsan Yavuz
Journal: Journal of Clinical Oncology (2023)

e23526 Background: The presence of frequent genetic alterations activating the tyrosine kinase (TKI) signaling pathway has recently led to a more targeted therapeutic approach. We describe our institutional experience using pazopanib for pediatric sarcomas. Methods: We performed a retrospective, IRB approved, chart review of all patients with sarcoma treated with pazopanib off-study at Ankara University Pediatric Oncology Clinic between 2019–2021. Results: Twenty-five patients were identified. Median age at commencement of pazopanib treatment was 13 years old (range 4 to18 years; 15 male: 10 female). Median duration on treatment with pazopanib was 16 months (range, 2 to 33). The median duration between the diagnosis of sarcoma and the beginning of pazopanib was 17.0 months (range, 1 to 80 months). Twelve of 25 patients due to metastatic disease at diagnosis, pazopanib was started with first-line chemotherapy and/or continued as maintenance therapy (Group 1). In the remaining 13 of 25 patients, received a second-line chemotherapy with pazopanib was administrated due to relapsed disease (Group 2). Nine patients (36.0%) ( 2 patients in group 1 and 7 patients in group 2) had died from progressive disease ranging between 13 and 70 months (median 33 months) after the diagnosis. OS rate was 64,0% in the entire cohort; group 1 and group 2 were 83,3%, and 46,2%, respectively. The overall median OS was 69.4 months. No new pazopanib-related adverse effects were identified. Conclusions: Pazopanib appears to be an effective treatment for pediatric sarcoma. Treatment with pazopanib is well-tolerated and could have a role to maintain response in patients with pediatric sarcoma. Further studies are needed to better define the use of this regimen in the upfront management of those patients.
Association of lymph node examination during resection with overall survival (OS) and healthcare costs in patients with early non–small-cell lung cancer (eNSCLC).
Authors: Jay M. Lee, Tu My To, Chia-Wei Lin, Shu Wang, Ann Johnson, Janet Lee
Journal: Journal of Clinical Oncology (2023)

e20567 Background: To evaluate the effect of LN examination status on OS and healthcare costs in patients (pts) with eNSCLC. Methods: Retrospective observational study of pts with resected stage IA-IIIB NSCLC (AJCC 7th ed) from SEER data linked with Medicare claims. Eligible pts were ≥65 years at diagnosis (Jan 2010-Dec 2017), had surgery ≤1 month before or 12 months after diagnosis and were continuously enrolled in Medicare Parts A and B for ≥6 months before diagnosis and in Parts A, B and D up to 6 months post-surgery or date of death. Pts were analyzed by LN examination status: no examination (pNX), examination and no LN metastasis (pN0) and examination with N1 (pN1) or N2 (pN2) metastasis. Extended Cox proportional hazards models presented OS hazard ratios (HRs) for specific time periods. Total healthcare costs per patient per month (PPPM) were analyzed using a gamma-log regression model. Results: A total of 9448 pts were included: 996 pNX (11%), 6457 pN0 (68%), 1003 pN1 (11%) and 992 pN2 (10%). pNX pts were slightly older with lower median income, more comorbidities and more baseline smoking history vs other LN examination status cohorts. Stage distribution in pNX and pN0 pts appeared similar. Grade 3/4 tumors were less prevalent in pNX (n = 301, 30%) and pN0 (n = 1934, 30%) pts relative to pN1 (n = 482, 48%) and pN2 pts (n = 424, 43%; P&lt; 0.001). Unadjusted OS was worse for pN1 and pN2 vs pN0 pts and was similar between pNX and pN2 pts. Adjusted OS showed higher risk of death for pN1 and pN2 vs pN0 pts; this risk decreased over time. pNX pts also had higher risk of death vs pN0 pts. Adjusted marginal mean follow-up costs were lowest for pN0 and highest for pN2 pts (All P &lt; 0.001). Costs were higher, but not statistically significant ( P= 0.591) in pNX vs pN0 pts. The majority of total healthcare costs (62-65%) were due to inpatient services. Conclusions: Stage distribution in pNX pts was more similar to that of pN0 than pN1/2 pts, likely due to understaging from lack of LN examination. However, prognosis in pNX pts was nearly identical to that of pN2 pts, suggesting missed LN metastasis diagnosis in a substantial proportion of pNX pts. Despite worse OS in pNX vs pN0 pts, healthcare costs in pNX pts were not significantly higher, which may reflect underutilization of systemic therapy in pts with resected eNSCLC. [Table: see text]
Beyond the standards: The impact of provider collaboration on referrals to genetic counseling.
Authors: Eric S Fowler, Laura Moreno, Maurie Markman
Journal: Journal of Clinical Oncology (2023)

10611 Background: The Commission on Cancer standards require institutions to monitor genetic assessment for a selected cancer site, providing an opportunity to increase referrals to genetic counseling. Genetic counseling, risk assessment, and testing improve patient care, outcomes, and facilitate cascade testing in families. This study investigated how collaboration with referring providers through education, feedback, and ongoing communication impacted referrals to genetic counseling. Methods: Study participants included new patients with colorectal cancer (CRC) diagnosed under age 50 presenting to our institution from July 2021 to September 2022. Patients were excluded if they did not return after initial visits. Baseline and intervention time periods were compared. Interventions to increase referrals included communication with the medical staff through memoranda co-authored by genetic counselors and physician champions, presentations by genetic counselors at tumor board, medical oncology, cancer committee meetings, and emails providing quarterly and final outcomes. Descriptive statistics were utilized to review categorical data, with baseline and intervention referral rates compared with the Pearson Chi-Square Test. Results: 133 patients met referral criteria with ages at diagnosis ranging from 19-49 years old. Mean (and median) patient ages were comparable between baseline and intervention study periods: 42.5 (45) and 43.0 (45), respectively. In the baseline period, 10/32 (31.3%) patients were referred to genetic counseling. In the intervention period, 58/101 (57.4%) patients were referred to genetic counseling representing a 26.1% increase over baseline. The Pearson Chi-Square Test yielded a p-value of 0.01. Referral rates varied by quarter (collaboration/education began in mid-Q2): Q1 - 26.7%, Q2 - 45.8%, Q3 - 77.8%, Q4 - 60.0%, and Q5 - 34.4%. Conclusions: Collaboration and communication with referring providers resulted in statistically and clinically significant increases in referrals to genetic counseling. The increase in referrals was most pronounced immediately after collaboration began and declined by the last quarter. This study highlights the importance of genetics educational initiatives and ongoing communication in the oncology setting, and the need for alternative and more sustainable strategies to maintain and increase referrals to genetic counseling. Referrals to genetic counseling facilitate the provision of cancer screening guidelines for patients and their families, based on genetic test results and personal/family histories, and reinforce the importance of cascade testing where appropriate. [Table: see text]
Understanding the motives to seek additional care at non-governmental organizations.
Authors: Cynthia Villarreal-Garza, Arantxa Ramirez, David G Gonzalez-Sanchez, Daniela Vazquez Juarez, Alejandra Platas, Ana Laura Platas, Samuel Rivera, Marta Zapata-Tarres, Miguel Enrique Cuellar Mendoza
Journal: Journal of Clinical Oncology (2023)

e18766 Background: Providing patient-centered comprehensive breast cancer (BC) management remains a global health challenge. In Mexico, public health institutions (PHIs) are the largest providers of BC care. They seek to offer quality BC treatment for their constituents while facing financial and operational challenges accentuated by the increasing prevalence of BC. This system leaves patients with unmet needs, especially limited access to supportive care services. Some non-governmental organizations (NGOs) have been created to fulfill these gaps. This study aims to understand the unmet needs perceived by BC patients at PHIs and their motives to contact NGOs for complementary services. Methods: An online survey was created and distributed to BC patients that received care at PHIs and had contacted Médicos Investigadores en la Lucha Contra el Cáncer, a BC NGO, from June 2022 to July 2022. The questionnaire consists of multiple-choice questions and a comments section. Results: We received 93 responses. The median age (range) was 51 years old (31-68). Most participants were residents of Mexico City and the State of Mexico, 97%. The most frequently reported clinical stages were stage 2 and stage 3, 31% and 40% respectively. Medication availability and diagnostic services were considered above average, 76% and 71% respectively. Patients referred that 78% of nursing services, 69% of primary and 82% of secondary/tertiary level care physician services were above average. The majority of participants, 91%, reported having unmet needs during their treatment. Table 1 describes the participant’s perceived needs including adequate information and referral to other integral health services within the institution like pain management, physical therapy, mental health services, and nutrition. A recurring comment reported by patients was that not enough time was dedicated to answering their concerns. Conclusions: This study shows that PHIs struggle to adequately provide comprehensive BC management. There is a high perception of unmet needs and a low referral rate to pain management, physical therapy, nutrition, and psychology services. However, patients consider the services provided by doctors and nurses as above average and are satisfied with the diagnostic services and medications provided by the institution. Future studies need to be conducted to understand the barriers to adequate referral to comprehensive care services and how NGOs address these unmet needs. [Table: see text]
Neoadjuvant sintilimab combined with chemotherapy in resectable locally advanced non-small cell lung cancer: A retrospective study.
Authors: Cunli Yin, Bin Liu, Jun Ge, Bin Hu, Xi Yang, Lingna Kou, Bo Tian, Chenghao Wang, Siru Li
Journal: Journal of Clinical Oncology (2023)

e20556 Background: In recent years, neoadjuvant immunotherapy with chemotherapy has shown increasing promise for locally advanced non-small cell lung cancer (NSCLC). However, more real-world clinical outcomes are needed. In this study, we aimed to evaluate the safety and efficacy of sintilimab combined with chemotherapy as neoadjuvant therapy in patients with potential resectable NSCLC. Methods: We retrospectively reviewed thirteen patients with previously treated NSCLC receiving neoadjuvant chemoimmunotherapy in Sichuan Cancer Hospital between February 2021 and February 2023. Sintilimab injection (intravenously,200mg, iv, d1, q3w) and platinum-based chemotherapy were administered intravenously every 3 weeks, with surgery planned approximately 4-11 weeks after the last dose. The primary endpoint of the study was pathologic complete response (pCR). The secondary endpoints were objective response rate (ORR), and safety. Results: All patients received sintilimab combined with platinum-based chemotherapy for two to four cycles before. None of them needed a reduced initial dose or delay due to intolerable adverse events. A total of nine patients (69.2%) achieved pCR. Nine patients experienced neoadjuvant treatment-related adverse events (TRAEs). Only one patient (7.6%) experienced grade 4 neoadjuvant TRAE. Conclusions: Neoadjuvant sintilimab plus platinum-based chemotherapy was feasible and safe for patients with resectable stage IIB-IIIB non-small-cell-lung-cancer.
Primary concerns and goals of care identified by people receiving hematopoietic stem cell transplantation (HSCT).
Authors: Tiffany T. D'cruze, Julie R. Doherty, Christi Ann Hayes, Kenneth R. Meehan, Kate L. Caldon, Charlotte M. Coughenour, Anna N.A. Tosteson, Aricca D. Van Citters
Journal: Journal of Clinical Oncology (2023)

e18717 Background: Patient-centered care requires an understanding of patient values in order to prioritize goals for treatment. Pre-visit questionnaires (PVQs) completed by patients prior to a visit can elicit patient concerns and improve patient and provider communication. In this pilot study, we aimed to identify the primary concerns and goals of care expressed by people receiving HSCT using an agenda setting intervention. Methods: Adults receiving HSCT at an NCI comprehensive cancer center completed an electronic PVQ prior to each visit. Each patient was asked: 1) their top two concerns to address during the visit, 2) goals of care, and 3) what had been going well since the last visit. We conducted a qualitative analysis of patient responses between January to December 2022. Team members created an initial codebook and two reviewers independently coded patient responses until reaching consensus. Results: 71 HSCT patients completed one or more PVQs, for a total of 202 PVQs. Most patients were male (n = 41, 58%); and average age was 60+13 years. The most common concerns identified prior to visits included physical issues (n = 64, 32% of visits) and planning ahead issues (n = 39, 19%). Physical symptoms most often included stable or increased pain (n = 26, 41%) or decreased energy (n = 21, 33%). Planning ahead issues most often focused on questions about treatment (n = 23, 60%). Although patients were able to select multiple concerns associated with the visit, patients categorized 30% (n = 60) of visits as a “routine visit” and 26% (n = 53) of PVQs did not include a top concern. When asked what mattered most for the visit, patients cited achieving personal goals (n = 21, 45%). Finally, when asked to describe what went well in the prior week, patients most often identified increased energy (n = 21, 23%) or social activities (n = 15, 16%). Conclusions: Open-ended agenda setting pre-visit questionnaires provide valuable insight into the HSCT patient experience. PVQs provide an opportunity for clinicians to understand and respond to their patients’ concerns and goals while partnering to create treatment plans that best meet shared goals. These data demonstrate the feasibility and utility of PVQs in this medically complicated patient population. Future opportunities include examining the impact of agenda setting on patient satisfaction and outcomes. [Table: see text]